Robinson A, Thomson R G
Department of Epidemiology and Public Health, School of Health Sciences, Medical School, Newcastle upon Tyne NE2 4HH, UK.
Qual Health Care. 2000 Dec;9(4):238-44. doi: 10.1136/qhc.9.4.238.
The quality of patient care is dependent upon the quality of the multitude of decisions that are made daily in clinical practice. Increasingly, modern health care is seeking to pursue better decisions (including an emphasis on evidence-based practice) and to engage patients more in decisions on their care. However, many treatment decisions are made in the face of clinical uncertainty and may be critically dependent upon patient preferences. This has led to attempts to develop decision support tools that enable patients and clinicians to make better decisions. One approach that may be of value is decision analysis, which seeks to create a rational framework for evaluating complex medical decisions and to provide a systematic way of integrating potential outcomes with probabilistic information such as that generated by randomised controlled trials of interventions. This paper describes decision analysis and discusses the potential of this approach with reference to the clinical decision as to whether to treat patients in atrial fibrillation with warfarin to reduce their risk of stroke.
患者护理质量取决于临床实践中每天做出的众多决策的质量。现代医疗保健越来越多地寻求做出更好的决策（包括强调循证实践），并让患者更多地参与到有关其护理的决策中。然而，许多治疗决策是在临床不确定性的情况下做出的，并且可能严重依赖于患者的偏好。这导致了人们尝试开发决策支持工具，以使患者和临床医生能够做出更好的决策。一种可能有价值的方法是决策分析，它试图创建一个合理的框架来评估复杂的医疗决策，并提供一种系统的方法，将潜在结果与概率信息相结合，例如干预措施的随机对照试验所产生的信息。本文描述了决策分析，并参照关于是否使用华法林治疗心房颤动患者以降低其卒中风险的临床决策，讨论了这种方法的潜力。
